Palliative medicine--part 2.

With the recent release of the report from The Institute of Medicine regarding terminal patients, palliative medicine could receive much needed attention among medical specialties in the form of improving education, advanced research, and improved reimbursements. Thus, we continue our two-part series on palliative medicine. In this section, we discuss the assessment and management of symptoms like constipation, nausea/vomiting, hypercalcemia, and hydration.

Epidural and intrathecal analgesia is effective in treating refractory cancer pain.

The use of neuraxial (intrathecal and epidural) analgesia has been suggested in treatment guidelines put forth for the treatment of refractory cancer pain. We review the literature and present our algorithm for using neuraxial analgesia. We also present our outcomes using this algorithm over a 28-month period.

Symptomatic hypogonadism in male survivors of cancer with chronic exposure to opioids.

Background: Profound hypogonadism has been noted in patients receiving intrathecal opioids. The purpose of the current study was to determine whether chronic consumption of oral opioids by male survivors of cancer also would lead to central hypogonadism and whether this hypogonadism was associated with symptoms of sexual dysfunction, fatigue, anxiety, and depression.

Methods: A case-control study was conducted at The University of Texas M.

Improvement in sexual function after reduction of chronic high-dose opioid medication in a cancer survivor.

Objective: To demonstrate improvement in sexual function after reduction of opioids.

Methods: This was a retrospective examination of a single patient at the cancer pain management clinic at M.D.

Hypogonadism and sexual dysfunction in male cancer survivors receiving chronic opioid therapy.

The purpose of this study was to determine the prevalence of central hypogonadism and sexual dysfunction in male cancer survivors exposed to chronic high-dose oral opioid therapy. We studied 20 male patients with cancer-related chronic pain who were disease-free for at least one year. All patients consumed at least 200 mg-equivalent of morphine on a daily basis for at least one year.